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CLINICAL LABORATORY OBJECTIVES AND SUGGESTED ACTIVITIES Week 1 2-15 Topic Clinical Objectives Suggested Activities CLINICAL ORIENTATION Demonstrate integration of the Core Components of associate degree nursing practice: Professional Behaviors Communication Assessment Clinical Decision Making Therapeutic Nursing Interventions Collaboration Teaching and Learning Managing Care Orient to routines, policies and physical set-up of unit. Review charts, forms and documentation expectations. Meet the Nurse Manager, as well as other nurses and staff. Locate the agency’s Emergency Preparedness Plan/ Disaster Plan . Review each item as noted in the course orientation in the NUR 214 Course Outline. PEDIATRIC INPATIENT CLINICAL Demonstrate integration of the Core Components of associate degree nursing practice: Professional Behaviors Communication Assessment Clinical Decision Making Therapeutic Nursing Interventions Collaboration Teaching and Learning Managing Care Assess developmental level, vital signs, cardiac, neuro and respiratory status. Assess learning needs. Consider formulating the nursing diagnoses of Delayed Growth and Development.. Develop and implement a nursing care plan for a pediatric patient. Implement by Calculating safe dosage ranges, safe oral fluid intake and safe IV rate. Administering medications. Evaluate the effectiveness of care provided. 1 Week 2 Topic Clinical Objectives CHRONIC ILLNESS AND HEALTH PROMOTION Demonstrate integration of the Core Components of associate degree nursing practice: Communication Assessment Therapeutic Nursing Interventions Collaboration Teaching and Learning PHYSICAL ASSESSMENT Respiratory Cardiac Neuro Demonstrate integration of the Core Components of associate degree nursing practice: Assessment Suggested Activities Interview or discuss in preconference a patient with a chronic illness. Assess for risk factors associated with chronic illnesses. Assess a patient’s readiness to change health behaviors. Assist the patient to use adaptive coping strategies to deal with chronic illness. Collaborate to determine community support services available. Teach the patient about health promotion activities. Perform these assessments on a patient: Chest and Lung Cardiac Carotid Arteries and Jugular Veins Neuro Check 2 Week Topic Clinical Objectives 3 MANAGER OF CARE Priority Setting Transcription of Orders Demonstrate integration of the Core Components of associate degree nursing practice: Professional Behaviors Communication Clinical Decision Making Collaboration Managing Care Suggested Activities Set priorities for a group of patients. Round on a group of patients and reorder priorities as necessary. Identify variables that affect how and when nursing care is delivered. Observe a nurse transcribing orders. Identify the systems in place to prevent omissions and errors. Assess a patient with acute or chronic liver disease. Renal Dysfunction Consider formulating the nursing diagnoses of Impaired Urinary Elimination Risk for Infection Develop and implement a nursing care plan for a patient undergoing a fluid challenge dialysis Evaluate effectiveness of care provided by correlating renal function test results with clinical findings and treatment. 3 Week Topic Clinical Objectives 4 ELIMINATION Dialysis Liver Dysfunction IMMUNITY Corticosteroid Therapy Use the Nursing Process to provide nursing care for a patient with these conditions: Assess the patient, significant support person(s) and the environment. Formulate an individualized high priority nursing diagnosis related to the patient’s basic needs. Plan outcomes and individualized high priority therapeutic nursing interventions. Implement safe and accurate nursing care and prescribed medical care. Evaluate care provided and modify care based on this evaluation. Suggested Activities Assess a patient on long term high dose steroid therapy. liver biopsy paracentesis. Implement by Assisting with diet selection. Collecting specimens. Administering medications. Evaluate the effectiveness of care provided by correlating liver and renal function test results with clinical findings and treatments. Demonstrate Professional Behavior, Communication, Collaboration or Managing Care by assisting a patient to cope with the challenges of living with a chronic illness. Demonstrate integration of the remaining Core Components of associate degree nursing practice: Professional Behaviors Communication Collaboration Managing Care 4 Week Topic Clinical Objectives Suggested Activities Examine position descriptions for nursing personnel on the unit. Assignment Delegation Complete the Manager of Care experience. This is an experience that will be assigned to each student one week during the weeks 3-15 of the semester. Determine the type of nursing care provided on the floor (e.g. primary, team, family centered). Determine how the assignment is made and communicated among the nursing team. 5 Week 5 Topic RESPIRATORY Respiratory Assessment Asthma COPD Clinical Objectives Suggested Activities Use the Nursing Process to provide nursing care for a patient with these conditions: Assess the patient, significant support person(s) and the environment. Formulate an individualized high priority nursing diagnosis related to the patient’s basic needs. Plan outcomes and individualized high priority therapeutic nursing interventions. Implement safe and accurate nursing care and prescribed medical care. Evaluate care provided and modify care based on this evaluation. Assess a patient with asthma or COPD. Consider formulating the nursing diagnoses of Ineffective Airway Clearance Impaired Gas Exchange Impaired Breathing Pattern Develop and implement a nursing care plan for a patient with an acute or chronic obstructive respiratory disease. Implement by performing: Respiratory assessment Teaching about nebulizers, MDI’s, DPI’s, flutter valves and peak flow meters. Teaching about an asthma management plan. Evaluate the effectiveness of respiratory treatments by comparing pretreatment and post treatment assessments. Demonstrate Professional Behavior, Communication, Collaboration or Managing Care by assisting a patient to cope with the challenges of living with a chronic illness. Demonstrate integration of the remaining Core Components of associate degree nursing practice: Professional Behaviors Communication Collaboration Managing Care 6 Week Topic Clinical Objectives Suggested Activities 6 RESPIRATORY Respiratory Tract Infections Techniques to Improve Ventilation Artificial Airway Management Respiratory Acidosis Use the Nursing Process to provide nursing care for a patient with these conditions: Assess the patient, significant support person(s) and the environment. Formulate an individualized high priority nursing diagnosis related to the patient’s basic needs. Plan outcomes and individualized high priority therapeutic nursing interventions. Implement safe and accurate nursing care and prescribed medical care. Evaluate care provided and modify care based on this evaluation. Assess a patient with an acute respiratory infection. Demonstrate integration of the remaining Core Components of associate degree nursing practice: Professional Behaviors Communication Collaboration Managing Care Demonstrate Professional Behavior, Communication, Collaboration or Managing Care by assisting a patient to cope with the challenges of living with respiratory compromise. Consider formulating the nursing diagnoses of Hyperthermia Ineffective Airway Clearance Impaired Gas Exchange Impaired Breathing Pattern Develop and implement a nursing care plan for a patient with tuberculosis, LTB, epiglottitis, bronchiolitis or a tracheostomy. Implement by performing Breathing retraining. Oxygen or mist therapy. Suctioning. Chest physiotherapy. Evaluate the effectiveness of care provided by monitoring SpO2 as oxygen is tapered and/or treatments are provided. Evaluate ABG results. 7 Week 7 Topic RESPIRATORY Respiratory Failure Mechanical Ventilation End of Life Issues IMMUNITY HIV/AIDS Clinical Objectives Suggested Activities Use the Nursing Process to provide nursing care for a patient with these conditions: Assess the patient, significant support person(s) and the environment. Formulate an individualized high priority nursing diagnosis related to the patient’s basic needs. Plan outcomes and individualized high priority therapeutic nursing interventions. Implement safe and accurate nursing care and prescribed medical care. Evaluate care provided and modify care based on this evaluation. Assess a patient with respiratory failure, who may be on a ventilator. Assess a patient and significant support person(s) who may be facing end of life issues. Assess a patient living or dying with HIV/AIDS. Consider formulating the nursing diagnoses of Death Anxiety Dysfunctional Ventilatory Weaning Response Impaired Spontaneous Ventilation Develop and implement a nursing care plan for a patient receiving comfort care or who is receiving HAART for HIV/AIDS. Implement by performing Comfort care measures. Teaching about adherence to HAART therapy. Reviewing advanced directive documentation. Evaluate the effectiveness of care provided by monitoring Pain scores. CD4 and viral load lab values. Demonstrate integration of the remaining Core Components of associate degree nursing practice: Professional Behaviors Communication Collaboration Managing Care Demonstrate Professional Behavior, Communication, Collaboration or Managing Care by assisting a patient to cope with the challenges of living with a chronic illness, as well as those who are dying. 8 Week Topic Clinical Objectives Suggested Activities 8 CARDIAC Cardiac Assessment Hemodynami cs Hypertension Use the Nursing Process to provide nursing care for a patient with these conditions: Assess the patient, significant support person(s) and the environment. Formulate an individualized high priority nursing diagnosis related to the patient’s basic needs. Plan outcomes and individualized high priority therapeutic nursing interventions. Implement safe and accurate nursing care and prescribed medical care. Evaluate care provided and modify care based on this evaluation. Assess a patient with cardiac monitoring, hemodynamic monitoring or undergoing cardiac diagnostic testing. Assess a patient with hypertension. Demonstrate integration of the remaining Core Components of associate degree nursing practice: Professional Behaviors Communication Collaboration Managing Care Demonstrate Professional Behavior, Communication, Collaboration or Managing Care by assisting a patient to cope with the challenges of living with a chronic cardiac illness. Consider formulating the nursing diagnosis of Decreased Cardiac Output. Develop and implement a nursing care plan for a patient with hypertension. Implement by performing: Cardiac assessment An EKG. Cardiac monitoring. Teaching about cardiac diagnostic testing. Teaching about hypertension. Evaluate the effectiveness of care provided by monitoring blood pressure before and after the administration of an antihypertensive. 9 Week Topic Clinical Objectives 9 CARDIAC CAD/MI HF Cardiac Rehab Structural and Inflammatory Conditions of the Heart Use the Nursing Process to provide nursing care for a patient with these conditions: Assess the patient, significant support person(s) and the environment. Formulate an individualized high priority nursing diagnosis related to the patient’s basic needs. Plan outcomes and individualized high priority therapeutic nursing interventions. Implement safe and accurate nursing care and prescribed medical care. Evaluate care provided and modify care based on this evaluation. Demonstrate integration of the remaining Core Components of associate degree nursing practice: Professional Behaviors Communication Collaboration Managing Care Suggested Activities Assess a patient with CAD/MI, congenital or acquired structural defects, inflammatory cardiac conditions and/or Heart Failure. Assess a patient undergoing cardiac rehabilitation. Consider formulating the nursing diagnosis of Ineffective Therapeutic Regimen Management. Develop and implement a nursing care plan for a patient with chest pain. Implement by performing Cardiac assessment Daily weights. Monitoring of edema and lung sounds. Administration of cardiac medications. Monitoring for side effects of cardiac medication administration. Monitoring biochemical cardiac markers. Evaluate the effectiveness of care provided by monitoring a patient with chest pain and the response to treatment. Demonstrate Professional Behavior, Communication, Collaboration or Managing Care by assisting a patient to cope with the challenges of living with a chronic cardiac illness. 10 Week 10 Topic Clinical Objectives Use the Nursing Process to BLOOD AND IMMUNITY provide nursing care for a patient with these conditions: Immunity Assess the patient, significant Immunizations support person(s) and the Autoimmunity environment. Bone Marrow Formulate an individualized high Dysfunction priority nursing diagnosis – Neutropenia related to the patient’s basic – Thromboneeds. cytopenia Plan outcomes and – Anemia individualized high priority Hemophilia therapeutic nursing interventions. Implement safe and accurate nursing care and prescribed medical care. Evaluate care provided and modify care based on this evaluation. Demonstrate integration of the remaining Core Components of associate degree nursing practice: Professional Behaviors Communication Collaboration Managing Care Suggested Activities Assess a patient with an autoimmune, immunodeficient of bone marrow dysfunctional disease. Consider formulating the nursing diagnosis of Ineffective Protection. Develop and implement a nursing care plan for a patient with neutropenia, thrombocytopenia, anemia or hemophilia. Implement by performing: Instituting neutropenic precautions. Instituting bleeding precautions. Administering medications or blood products to restore blood counts. Evaluate the effectiveness of care provided by monitoring lab values, as well as patient safety. Demonstrate Professional Behavior, Communication, Collaboration or Managing Care by assisting a patient to cope with the challenges of living with a potentially fatal acute or chronic illness related to immune dysfunction. 11 Week Topic Clinical Objectives Suggested Activities 11 BLOOD AND IMMUNITY Hypersensitivi ty Organ and Tissue Transplantati on ENDOCRINE Pituitary Dysfunction Thyroid Dysfunction Metabolic Syndrome Use the Nursing Process to provide nursing care for a patient with these conditions: Assess the patient, significant support person(s) and the environment. Formulate an individualized high priority nursing diagnosis related to the patient’s basic needs. Plan outcomes and individualized high priority therapeutic nursing interventions. Implement safe and accurate nursing care and prescribed medical care. Evaluate care provided and modify care based on this evaluation. Assess a patient with allergies. Assess a patient who has had an organ or tissue transplant. Assess for risk factors or symptoms for/of SIADH or DI. Demonstrate integration of the remaining Core Components of associate degree nursing practice: Professional Behaviors Communication Collaboration Managing Care Consider formulating the nursing diagnoses of Risk for Infection Risk for Injury Develop and implement a nursing care plan for a patient with allergies, organ/tissue transplant, SIADH, DI, thyroid disorder or metabolic syndrome. Implement by performing Allergy teaching. Administering hormonal medications. Measuring waist circumference. Evaluate the effectiveness of care provided by monitoring lab values and response to medications administered. Demonstrate Professional Behavior, Communication, Collaboration or Managing Care by assisting a patient to cope with the challenges of living with an endocrine illness, or with metabolic syndrome. 12 Week 12 Topic Clinical Objectives Use the Nursing Process to CARDIAC provide nursing care for a patient Cardiac Dysrhythmias with these conditions: Assess the patient, significant – Identification – Pharmacosupport person(s) and the logic Therapy environment. – Electrical Formulate an individualized high Therapy priority nursing diagnosis Cardiac Arrest related to the patient’s basic needs. Plan outcomes and individualized high priority therapeutic nursing interventions. Implement safe and accurate nursing care and prescribed medical care. Evaluate care provided and modify care based on this evaluation. Demonstrate integration of the remaining Core Components of associate degree nursing practice: Professional Behaviors Communication Collaboration Managing Care Suggested Activities Assess a patient with a cardiac dysrhythmia. Assess the contents of the emergency cart and the workings of the emergency equipment. Consider formulating the nursing diagnosis of Risk for Injury. Develop and implement a nursing care plan for a patient with a pacemaker or AICD. Implement by performing Cardiac monitoring and rhythm interpretation. Administration of antidysrhythmic medications. Monitoring for side effects of antidysrhythmic medications. Evaluate the effectiveness of care provided by monitoring the effect of treatment on the cardiac rhythm. Demonstrate Professional Behavior, Communication, Collaboration or Managing Care by assisting a patient to cope with the challenges of living with an acute or chronic cardiac dysrhythmia. 13 Week 13 Topic Clinical Objectives Use the Nursing Process to NEUROLOGIC provide nursing care for a patient Neurologic with these conditions: Assessment Assess the patient, significant Increased support person(s) and the Intracranial environment. Pressure Formulate an individualized high – Assessment priority nursing diagnosis – Nursing Care related to the patient’s basic – Head needs. Trauma Plan outcomes and – Cranial individualized high priority Surgery therapeutic nursing Seizures interventions. CARDIAC Implement safe and accurate Shock nursing care and prescribed medical care. Evaluate care provided and modify care based on this evaluation. Demonstrate integration of the remaining Core Components of associate degree nursing practice: Professional Behaviors Communication Collaboration Managing Care Suggested Activities Assess a patient with a change in their neurologic status or one who has suffered a head injury or is s/p cranial surgery or before, after and during a seizure. Assess a patient for risk factors for and early signs of shock. Consider formulating the nursing diagnosis of decreased Intracranial Adaptive Capacity. Develop and implement a nursing care plan for a patient with increased intracranial pressure and/or a seizure disorder, and or one who is undergoing a neurologic diagnostic test. Implement by Performing a neurologic assessment. Instituting seizure precautions. Non-invasive BP and perfusion monitoring techniques. Evaluate the effectiveness of care provided by monitoring the effect s of care on intracranial pressure and/ or seizures. Demonstrate Professional Behavior, Communication, Collaboration or Managing Care by assisting a patient to cope with the challenges of living with a neurologic change. 14 Week 14 Topic Clinical Objectives Use the Nursing Process to NEUROLOGIC CNS Infection provide nursing care for a patient with these conditions: – Meningitis Assess the patient, significant – Encephalitis support person(s) and the Peripheral environment. Nerve Disease Formulate an individualized high – Cranial priority nursing diagnosis Nerve Dysfunction related to the patient’s basic – Guillianneeds. Barre Plan outcomes and Syndrome individualized high priority Spinal Cord therapeutic nursing Injury interventions. Implement safe and accurate CVA nursing care and prescribed medical care. Evaluate care provided and modify care based on this evaluation. Demonstrate integration of the remaining Core Components of associate degree nursing practice: Professional Behaviors Communication Collaboration Managing Care Suggested Activities Assess a patient with and acute or chronic neurologic condition. Consider formulating the nursing diagnoses of Sensory Perceptual Deficit Impaired Verbal Communication Urinary Incontinence Urinary Retention Autonomic Dysreflexia Develop and implement a nursing care plan for a patient with a CVA. Implement by Instituting droplet precautions. Instituting aspiration precautions. Instituting fall precautions. Instituting skin care protocol. Evaluate the effectiveness of care provided by monitoring the safety of the patient whose neurologic status is impaired. Demonstrate Professional Behavior, Communication, Collaboration or Managing Care by assisting a patient to cope with acute neurologic illness and/or the aftermath of CVA. 15 Week Topic Clinical Objectives 15 NEUROLOGIC Chronic Neurologic Disorders – Parkinson’s disease – Alzheimer’s disease – Multiple Sclerosis – Developmental Disabilities Use the Nursing Process to provide nursing care for a patient with these conditions: Assess the patient, significant support person(s) and the environment. Formulate an individualized high priority nursing diagnosis related to the patient’s basic needs. Plan outcomes and individualized high priority therapeutic nursing interventions. Implement safe and accurate nursing care and prescribed medical care. Evaluate care provided and modify care based on this evaluation. Demonstrate integration of the remaining Core Components of associate degree nursing practice: Professional Behaviors Communication Collaboration Managing Care Suggested Activities Assess a patient with a chronic neurologic condition or developmental disability. Consider formulating the nursing diagnoses of Impaired Memory Impaired Thought processes Impaired Mobility Develop and implement a nursing care plan for a patient with a chronic, disabling neurologic disease. Implement by Teaching about expected nature of the disease. Considering necessary safety measures Working with caregivers to understand the needs of the patient. Evaluate the effectiveness of care provided by monitoring the quality of life of patients and caregivers. Demonstrate Professional Behavior, Communication, Collaboration or Managing Care by assisting a patient to cope with the challenges of living with a chronic neurological illness or developmental disability. 16 17